~ Ever wonder what it's like for a diabetic trying to juggle being active? What do we think about? Well, I can share my story.

Category Archives: Product Reviews

Last year I wrote comparing the Animas Vibe and the Dexcom standalone receiver. At that time, I summarized my thoughts that while the Vibe had great features, I felt the Dexcom standalone was a better unit overall. The wonderful thing about opinions is that they can change. 🙂 Maybe not change, but evolve or adapt to suit. At the time of the review I wrote that the Vibe was better for running (less to carry) and for anything involving water. Well, Newfoundland is wet quite a lot of the time and I ran a lot in 2014. Still, what changed? I have an amazing Animas rep who loaned the pink beast loaner pump for my Marathon – and it performed smashingly well and made running that much less complex that I was swayed. Still, there was the issue of the cost of a whole pump, but Animas Canada offered an upgrade from the Ping to a Vibe at a “nominal” cost I decided to bite the bullet. I say nominal because when I bought the ping state-side I was told 99$ upgrade, but Animas Canada was not on board with that. C’est la vie, but I do mention it because it costs more to update in Canada vs USA.

So what have I learned being on a Vibe and abandoning my standalone receiver since August? Rather than rehash what I wrote last time comparing the two, I’ll jump into a more in depth review of each aspect of the pump and why ultimately, it’s better for me right now.

Interface

The Animas Vibe has improved the Ping interface in a few ways. For those of you familiar with the Ping, you will even start to wonder if it’s just the same pump; however, some great changes have occurred. First of all, there is a left and right arrow in the settings window!

That doesn’t sound like much, but it’s a huge deal that you can go left and right when trying to tweak settings. The quick bolus button is still there on the right side of the pump, but the contrast button on top now serves a great purpose. It’s a quick access button to the pump CGM trend graph. One push brings up the last viewed graph, and then subsequent pushes go through various contrasts – very helpful if you are trying to view on a bright sunny day. However, if you accidently hit another button while trying to access the pump, the contrast button won’t just bring you to that screen – it only goes to the trend graph when the pump is not “awake”, so you have to make sure you don’t manhandle it in a rush trying to see a number.

One issue with integrating pumps and CGMS is the extra button pushes required to get into the CGM. It’s not too bad on the Vibe – yes, it’s buried one submenu; however, the quick access button generally alleviates this issue. Maybe in future models they can have a dedicated CGMS button (rather than dual purposing the contrast button), but I understand that they didn’t want to make a button that is solely for CGMS when market uptake is not always there.

One downside is that the Vibe is like the Ping – it lags and doesn’t respond while it’s dishing out it’s little blast of basal insulin. So, if you are trying to navigate the pump while it is basal dosing it will seem like it’s frozen. This was less of an issue with the ping because you simply didn’t interact with it as much for two reasons – no integrate CGM and the Ping BG Remote. However, the Vibe eschews the ping blood meter (which I’m okay with, it was clunky, large, and I wasn’t a huge fan of it) and also has an integrated CGMS. With integrated CGMS you interface with the Vibe a lot more, and that means you’ll get these freezes from time to time. Usually it’s innocuous, but if you are trying to do something while say, running, it can be annoying!

The CGM Portion

Rather than delay talking about it, let’s get right into it – the CGM is why you would upgrade. While the Dex stand alone receiver is fantastic, it’s another device to carry. This isn’t much of a problem if you have pocket room or just day to day doing stuff, but when you’re active the convenience of integration is appealing. But integration is useless if it’s done poorly (ever try and read a Medtronic CGMS graph?). So how did the Vibe fare?

For the most part, it does a pretty bang up job with some trade-offs that you really have to decide for yourself. In the good camp is the most useful screen on the pump – before the usual 1, 3, 6, 12 and 24 hour trend graphs is a screen that shows your trend arrow and your insulin on board (IOB). This is fantastic! If you set this as your home screen and are running you can easily see “okay, I have 1 unit active, I’m a 4.8 mmol/L with a down arrow, I should eat!”. Sometimes when I’m active it’s too little to rely on listening to my body to read the signs of a low. They can hit faster at times during activity, so knowing my IOB and trend I can gauge if I need to fuel up based on my intensity and duration remaining.

Seriously, this screen and the one-hour trend are the two screens I use while exercising. The three hour screen is useful for day-to-day management and especially useful in gauging “success” in post-meal glucose rise.

However, on the flip side – the 12 and 24 hour graphs are nearly useless due to the size of the screen and the time it takes to render them.

I’m wishy washy on the 6 hour screen; it’s useful for trying to manage a sticky high and figure out if you are making progress.

On the neutral front, both the Dexcom and Animas interface annoy me for one simple reason – you cannot scale the vertical axis. I can only think of one time I’ve needed a glucose over 22.5 mmol/L, and that was when driving from Phoenix to Las Vegas with a jammed up infusion site. Other than that, I am treating the high before it happens. By not allowing customizable Y axis it really causes me to squint since I tend to prefer my numbers in the tight control band I set. I find the inability to change Y axis scale compromises the minutiae of detail that folks with tighter control may appreciate in point to point trend analysis that gets lost when zoomed out.

Alarms

The Vibe has two areas that I’m not please with – alarm volume, and alarm tones (or lack of variability). A huge selling point of the Dexcom stand alone is the alarm volume and customization. On hypo alert that thing was a saint waking me up in some extreme lows. If you set it on a table it would vibrate you awake before the darn sounds went off! The Vibe is a bit of a step back. By sticking to the form factor it does not allow you to get very loud. It does vibrate first, before an alarm. Most times I feel this, except when I’m running or cycling and there is already so much movement that a small, low frequency vibration is going to go unnoticed. It wakes me up more often than not (and if not me, my wife), but sometimes it can take a few minutes before it’s successful. It works, but it’s not as good as it could be. Also, you cannot customize alarms like the Ping or have different sounds for different alarms. I really liked this on the Dexcom stand alone, but my wife liked it infinitely more as she knew if she had to panic to wake me up (low), or get ready for a long, drawn out, grumpy me to try and wake me up during an overnight high. It also helps us figure out, without glancing, what is going on – and that is really helpful when you are active. Sometimes you can’t just look at the screen.

Finally, if you are one that likes to silence it all, I must point out that there is one alarm you cannot silence – it’s the calibration sound. Say you bolus using eZBG – enter a blood glucose and bolus accordingly. After the pump delivers it’s bolus it then lets out a beep and asks you if you’d like to use it as a calibration. I have not been able to silence this beep, so just be aware that you can beep at times when you may not want to (think savasana in yoga).

Glad they kept it the same

So one thing Animas really got right was their metal belt clip. That thing is bullet proof! I clip it on to everything – every day stuff like belts, jean pockets, boxer shorts, bed sheets, etc. For cycling it clips to jersey pockets or wind vests – even the bottom hem of a gilet without pockets! I’ve had no issues during 70 km/h descents and vigorous out of the saddle climbs. See if you can spot the pump on my outrageous coffee themed jersey – no problem on an off-road mud ride! Climbing I can clip it to my leg loop of my harness without much of an issue unless I’m doing off widths.

Prior to getting a Vibe I had thought the Dexcom was more convenient in certain sports (like cycling, climbing); however, in cycling I find that I like having my bars clear; especially here in Newfoundland where you’re always climbing! Being able to ride the flats is worth having to slow down or stop to read your pump – and that’s if you even have to, because honestly, reaching back to check your pump is not much different than digging in your jersey for food. And then there’s the waterproof factor – more on that later. For climbing it’s one less item to carry, and it’s not like I’m going to be checking my BG while in the middle of a crux move. My wife is the only other person I trust with my blood monitor, and honestly, she’s also one of the few I trust to belay me, so – I’d rather her hands on the ATC than the Dexcom. Call me crazy but that’s my life line! 🙂

Another Ultimate Convenience

Waterproof – it should be apparent, this was a huge benefit of the Ping over Medtronic, and now Animas has made it possible to not worry about water and the Dexcom. In the past I’ve been paranoid about the Dexcom on wet rides and missed out on valuable BG information while waiting for the swim start of a tri with the added stress of leaving my Dexcom in transition and hoping it will pick me up when I got out of the swim.

My extreme test case was running with the Vibe during the Cape to Cabot 20K 2014 race – during Hurricane Gonzalo. Even if it was double digit temperatures, the wind and rain was causing me to go hypothermic. I was shaking at the start of the race form the cold – drenched to the core. The pump kept on ticking and worked admirably. You can’t get much more extreme than that. The picture doesn’t do it justice, but these are the conditions it survived (and as a bonus, it’s a shot of me photo bombing some real competitive runners).

But what about the future?

And here’s where I have concerns – the Vibe feels like a pump that’s half in the future and half in the past. It’s basically a ping with an attached CGMS, and that’s not bad – the Ping was a tank. But, this design decision has caused some compromises. Essentially, it’s not future proof. Dexcom has released an updated algorithm to their stand-alone receivers which cannot be uploaded to the Vibe. This is not a game changer (I still use the vibe), but the upgrade would really benefit me as it lowers MARD and especially the time to recover from lows.

Also, Dexcom is pushing ahead towards the Gen5 which will be a Bluetooth transmitter. This is a feature not found in the Vibe. They haven’t indicated yet if it will dual band, but I imagine it will be BT only. This is great for talking directly to smart phones, but not good for Vibe users. I can only hope Animas has something in the pipeline and considers future proofing pumps a bit better for the future. Dexcom tends to innovate faster than pumps, and right now that makes the Vibe a bit vulnerable in a year or two. Given the cost of pumps this is a concern.

Conclusion

While the Vibe may not be perfect, it’s a great stepping stone in integration and my pump of choice. I still have a fully functioning Dexcom receiver that has sat in it’s box since day 2 of being on the vibe. I don’t regret it – I’ve learned to adapt to the differences, and it’s made it more enjoyable. However, I am concerned about how vulnerable it is given the pace of innovation in CGMS technology.

On a side note – Animas has really stepped up their game in Canada. When I moved away in 2010 there was nary much heard about them, and now I find their support amazing. I’ve called in with an order and off hand mentioned that I had some issues with infusion sites and rather than chastise me for doing something wrong (here’s looking at you Medtronic), they connected me with a nurse (which I hesitated, see comment about previous chastise comment) who offered up some replacements! And my local rep? I can’t say enough kind words – she’s friendly, always willing to help, interacts with the local D community, and walks the walk of an active diabetic lifestyle. Seriously, she just did the Chicago Marathon this year – how cool is that; a pump rep and a role model for the community all in one.

One of my criteria for my timing of moving back to Canada was approval of the Dexcom G4 in Canada. I rely on the Dexcom so much it’s almost disturbing. For me, it’s been crucial in management of blood sugar and hypo prevention during exercise. However, I have yet to localize my CGMS receiver, so it still reads in mg/dL. Since that’s an out of pocket expense, I wanted to see if it made sense to get a mmol/L receiver, or if the newly approved Animas Vibe would be sufficient. For those not in the know, the Animas Vibe integrates the Dexcom G4 CGMS with the unit. It’s basically an upgraded Ping (although some would argue losing the remote meter is a huge deal), with lots of UI and usability adjustments and CGMS on the unit. Rather than review the Animas Vibe as a whole, what I wanted to do was review the Animas Vibe vs. the Dexcom G4 standalone receiver – which one is better for exercise? Is there still a place for a Dexcom G4 receiver, or is it redundant? Is there a place for both? If I had to choose, which one would I go with? The Newfoundland Animas rep sent me a surprise e-mail on Wednesday offering me a loaner Animas Vibe. She knew I was keen on trying it out. The extra surprise – it’s an awesome pink unit. So I made plans to do a long run this weekend to see how the Vibe would fare – running is the one activity where I sometimes find I run out of places to put things; and the fact that the Dexcom receiver is not waterproof makes it a necessity to carry it in a LokSak or ziploc bag depending on the weather. So without further ado, I powered it up, programmed it, and calibrated the CGMS the same as my receiver. Since my receiver was already running the numbers were slightly different. So Friday I took it on a bike ride, and thanks to the combo of old sensor and noise/friction from the wind jacket I lost the reception. At least both units failed. What’s interesting is the Vibe actually gave an error (and stopped the session), whereas the Dexcom receiver just showed a “lost signal”. So I put a new sensor in and got them both running with the same calibration – good news, they showed the same results. I’ve had this issue with Dexcom sensors before – it’s a combination of materials and sensor age that seem to lead to the lost communication. You can just restart, wait two hours and grab a new calibration, but my sensor was plenty old. I also made plans to try and run my first marathon – why not go big or stay home! 🙂 I’ll write more about that in another post, but let’s try and trim this one down and write about what I liked and didn’t like and what I learned. As usual, I started the run with my usual pre-run oatmeal. You can see my multinational setup – mmol/L and mg/dL playing together! Trust me, they are the same readings.

Pre race, real food, and diabetes tech

So, jokes aside, what did I think? Here’s a few talking points:

First of all, the best part – this screen. It shows the time, your current CGMS blood glucose, the trend arrow, and the insulin on board. This is almost everything you need to know, and the real value of having the units integrated. It’s a great screen, and the one I leave hotkeyed on the pump. Why do I say almost? Well, sometimes my sugar can start creeping up ever so slowly – the Dexcom algorithms still say it’s flat, but really it’s a slow creep up until I hit a high. So that flat can be misleading which is why it’s good to also actually see a few data points. You only get that on the pure graph screens. Still, if I am running, this is the main screen to see.

Best screen ever – CGMS, trend arrow and IOB

When you zoom out, the CGM graph is actually kinda hard to read on the Vibe, and this is my major pet peeve. The Dexcom screen is just bigger, and on top of that, they colour the dots white. Also, note the Dexcom shows time stamps so you have an idea at what time your trends are firing off. The markings are there on the vibe, but really not as easy to read. If you wanted to be scientific with your trends, you’d have to look at the time (4:53 pm in this photo), then figure out the scale (3 hours, so 6 ticks, so each tick is 30 minutes), then back off from that. At least on the Dexcom I can quick glance and see that around 1:30 PM I had a low alarm. I also find the green just harder to read. Dexcom’s colour scheme is red(low), white (in range) and yellow (high). Maybe it’s just the change to green that messes me up, but I found it a bit harder to read. Maybe it was my tinted sun glasses. Finally, font size is much smaller, especially on this screen – the blood glucose value is just harder to read than Dexcoms (and also harder to read than the above screen that I love). It’s all just a function of smaller screen real estate.

3 hour graph, less readable when you have tight control

These problems become more exacerbated when you zoom out. Now, for exercise purposes, you aren’t really going to be looking 6 hours (unless you’re doing an ultra) but for every day use this screen starts to lose it’s utility. If you were trying to make decisions on your blood sugar management based off this it would be tricky – you’d be better served to upload it to try and read it. I’ll touch on this later.

6 hour trend

The final photo evidence useability feature I want to touch on is thickness. The Dexcom G4 is svelte; it’s like an iPod. I find it very easy to slide it in and out of my tights pockets. All my running clothes are spandex – short tights and long. The hip pockets on these tend to be quite snug/compressed against the leg. The Dexcom easily slides in and out for a quick glance. I found myself having to fight to pull the pump out. This is also true of the Ping; however, I consult my Dexcom a fair amount and only pull the ping out to bolus. So this meant I spend more time trying to slide this in and out of my pocket. If you have numb fingers (like I did for the first half of this run) it can make it quite challenging!

Chunky!

So what else did I learn from a usability stand point. Here’s a short list of pros and cons. For the Vibe:

Waterproof – you could use this during a tri and not worry about leaving the receiver in transition. Also, you would not need to bag a receiver like I do on a wet day.

Integration means that if you need to action a BG you already have the pump out. So there’s an efficiency there.

Glucose trend and IOB on one screen – pure gold

You can’t drop it – since you’re hooked up with tubing you really can’t drop it on the ground and loose it. Well, at least you’d have to try really ahrd.

For the Dexcom:

Having a separate unit is perfect for sports like cycling where you can mount it. It’s much more convenient on the bike than trying to read your glucose off the pump on a bike. My pump sits in my jersey and rarely comes out.

Access to data – this is almost the key part to me. To get your CGMS readings off the pump you need to use Diasend. Diasend is an amazing website for integrating glucometers, cgms and pumps; however, it does not export data in raw formats like Dexcom Studio will. Now, I do realize that the Tidepool project has ways of doing it, but this is not for the every day diabetic. I love data, and the Dexcom’s USB port makes it possible to upload to Diasend AND Dexcom Studio. Dexcom studio will dump any data available into a tab de-limited format. I also like how Dexcom Studio does trends and identifies areas you are going high/low.

Readability – the separate receiver is just better to read

Range – I noticed the G4 receiver has a much longer range to communicate with the transmitter. You may not think it a huge deal, but I can envision scenarios where one may disconnect and leave technology behind – like crack climbing. I’ve been up an 80′ pitch and left my Dexcom on the ground and still had reception. The Vibe just won’t – probably battery life related.

Form factor – if you frequently check your glucose, getting the Dexcom out to look can be much quicker and easier to do since it’s so small.

Speed – the screen refreshes on the Vibe are slow whereas the Dexcom renders much faster

Alarms – sometimes I don’t feel the vibration alarms; however, the Dexcom alarms are also extremely loud.

Overall, if I could only have one, I’d choose the Dexcom receiver. It’s versatility to work well with every sport makes it a clear winner. On top of that, readability is key. Now I’m not saying the vibe isn’t an amazing product – it really is and I do hope to get one. It makes running simpler to plan, and for a long run it makes blood glucose management even easier with that one magic screen. However, that one screen, while amazing, is still no match for the total pack of the standalone receiver. Besides, in every day life I like being able to set my CGMS on my desk and work away. I don’t have to take my pump out to look at my levels. That goes a long way to feeling like we have a “normal” life. I plan to localize my CGMS receiver soon; and hopefully check a Vibe out in the near future. Both are great, but the Dexcom is my first choice for CGMS usage. I don’t think they are redundant – but I do feel like one is a better all-arounder. Summary:

Vibe is a great product, it really fixes a lot of usability issues with the Ping (but you loose remote bolus)